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Alcohol & Alzhiemer’s Disease

ASK DR. MINDY™

My aunt (80) was diagnosed with Alzheimer’s disease about 18 months ago (beginning to moderate). My aunt has always been a daily 2-drink person, and has recently begun to consume dangerous quantities of whisky in the early morning hours. Is there a correlation between alcohol and Alzheimer’s? Is there a resource that would help us determine when/if an intervention is called for?

–Anonymous, 57, Riverside

Answer:

Alcohol and Dementia Risk

The relationship between alcohol consumption and Alzheimer’s disease (AD) is complex but basically appears to support the old saying: “Everything in moderation….”

Many studies have focused on the negative effects of excessive alcohol consumption on the brain. Drinking too much alcohol can lead to alcohol brain toxicity, malnutrition (especially thiamine deficiency), and hepatic encephalopathy. Two chronic syndromes typically attributed to alcohol use are Wernicke-Korsakoff syndrome (characterized by severe memory loss and some executive dysfunction usually seen in middle-aged persons), and alcohol-related dementia (characterized by milder deficits in memory usually seen in older persons). These syndromes result from the persisting effects of excessive alcohol use.

Recent studies suggest that light to moderate alcohol use (defined as up to 1 drink/day or 3-4 drinks/day depending on the study) may actually decrease the risk of AD and other dementias. In a study of persons aged 60 years or older, the consumption of alcohol was associated with a 34% lower risk of developing dementia over the course of 16 years. Another study found an approximately 35% reduction in the risk of developing dementia among those who drank up to 14 drinks/week compared to those who did not drink at all. A study following 2,258 nondemented individuals found that adherence to a traditional Mediterranean diet, which includes moderate consumption of alcohol, resulted in a significant reduction in the risk of AD. Moderate drinking has been associated with an approximately 50% reduction in the risk of combined dementia and mild cognitive impairment (MCI).

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There appears to be a U-shaped or J-shaped relationship between alcohol consumption and cognitive impairment, meaning that light to moderate drinking in mid to late life is associated with better cognitive performance and less cognitive decline over time than either not drinking or heavy drinking. Occasional drinking in midlife has been associated with a lower risk of MCI in old age compared to either nondrinking or frequent drinking. One study that followed individuals for an average of 23 years found that nondrinkers and heavy drinkers were both more than twice as likely to have MCI in old age than occasional drinkers. (The exception is those with the APOE 4 genotype, who have an increased risk of dementia with increasing midlife alcohol consumption.) In a study of 1681 people aged 65 years or older followed for an average of 7 years, both minimal (once a month or less) and moderate drinking (daily to weekly) were associated with lesser decline on cognitive tests. The beneficial effects of alcohol against cognitive decline appear concentrated in the areas of learning, executive functions, and general mental status.

For those who already have MCI, having about 1 drink/day (1.0 to 14.9 g alcohol/day) can reduce the rate of progression to dementia by about 85% compared to those with MCI who never drink. Interestingly, heavier drinking (1 or more drinks/day) and abstaining result in similar rates of progression from MCI to dementia. So in patients who already have MCI, up to 1 drink/day of alcohol or wine may decrease the rate of progression to dementia.

Some studies suggest that light to moderate drinking is associated with a reduced risk of dementia regardless of the type of alcohol consumed. Other studies suggest that red wine is more likely to have a protective effect compared to other alcoholic beverages. Moderate red wine consumption (up to 3 or 4 glasses/day), but not other alcoholic beverages, has been reported to lower risk of dementia and AD. Interestingly, one study found that mild wine consumption (1 or 2 glasses/day) was associated with a lower risk of AD but not other dementias. Some studies have even found an increased risk for dementia among monthly, weekly, and daily drinkers of beer and liquor.

It remains unclear how mild to moderate amounts of alcohol might be protective against AD or the progression of MCI to dementia. Alcohol consumption might protect from dementia by affecting the brain’s blood vessels and reducing vascular risk factors. Light to moderate alcohol consumption has been shown to lower the risk of coronary artery disease, ischemic stroke, and total mortality among the elderly. Some believe that various brain chemicals called neurotransmitters may be involved. Red wine may be especially protective due to the antioxidant effects of its polyphenols as well as its alcohol content. In fact, nonalcoholic red wine has also demonstrated a protective effect against dementia. Liquor has been shown to have less antioxidant activity than wine. It is also possible that the protective effect seen with moderate alcohol consumption may be an indicator of favorable social and lifestyle factors that are actually responsible for reducing the risk of dementia.

So based on recent studies, light to moderate alcohol drinking, particularly of red wine, may actually help prevent or delay the development of dementia. In this particular case, it is difficult to make a judgment about the aunt’s alcohol use without knowing more about her. The effects of alcohol on the brain are widespread and depend on multiple factors including acute versus chronic use, the amount of alcohol consumed, the duration and pattern of use, and gender, age and health status of the drinker. Her history of daily alcohol consumption may have initially delayed the development of AD; however, her recent increase in use may do more harm than good to her brain, heart, liver, and cancer risk.

Alcohol Abuse Among the Elderly

There is little research on alcohol abuse specifically among those diagnosed with dementia. Alcohol abuse among older adults in general is common, yet it is often under detected and misdiagnosed. On average, 4 or more drinks/day for women (or more than 7 drinks in a week) and 5 or more drinks/day for men (or more than 14 drinks in a week) is considered heavy drinking. Around 15.1 million Americans, including 4.6 million women, abuse alcohol. Some warning signs of alcoholism or alcohol abuse are listed in the table below. In some cases, alcohol abuse may be a sign of depression. Later-life alcohol abuse, depression, and dementia can occur together. However, there is no clear evidence to suggest that AD itself leads to alcohol abuse.

Various treatment programs are available to help people with alcohol problems including residential treatment centers, outpatient treatment programs, and hospital inpatient programs. Depending on the circumstances, treatment may involve an evaluation, intervention, detoxification, medication therapy, outpatient program or counseling, or a residential inpatient stay. Many alcoholism treatment programs include individual and group therapy, activity therapy, participation in alcoholism support groups, such as Alcoholics Anonymous (AA), and family involvement. If you are concerned about possible alcoholism and/or depression, consider contacting your physician, counselor, or other qualified professional. To find a treatment center anywhere in the United States, try the US Department of Health and Human Services’ Substance Abuse Treatment Facility Locator at http://www.findtreatment.samhsa.gov/.

Warning Signs of Alcohol Abuse or Alcoholism:

Building a tolerance to alcohol so that it takes more to feel the same level of intoxication

Becoming irritable when usual drinking time nears and alcohol is not available

Losing interest in activities and hobbies

Poor eating habits, loss of appetite, malnutrition, weight loss

Failure to care for physical appearance

Insomnia or difficulty sleeping

Bad dreams

Impotence

Continues drinking even after physical or psychological problems result

Having legal problems or problems with relationships, employment, or finances due to drinking

Drunk driving

Ask yourself:

Do you need a drink as soon as you get up?

Do you feel guilty about your drinking?

Do you think you need to cut back on your alcohol consumption?

Are you annoyed when other people comment on or criticize your drinking habits?

Answering yes to any of these questions may indicate a problem.

Dr. Mindy Kim-Miller is a trained medical physician who provides useful, but general answers to questions provided by online visitors. While Dr. Mindy can not provide specific medical advice or services, we hope you find her responses useful in your personal education. All information is provided for informational and educational purposes only and is not meant to be a substitute for professional medical advice, diagnosis or treatment. If you suspect you have an illness or disease, or a health related condition of any kind, seek professional medical care with an appropriate health care professional immediately. Do not postpone or delay seeking treatment or disregard professional advice based upon the general answers provided by Dr. Mindy. Dr. Mindy’s advice is not intended to substitute for a visit to your personal physician or other qualified health provider. Any specific medical concerns or questions you may have should be directed to your personal physician or other qualified health provider.